Social Capital and Health

Social capital is a by-product of our social relationships that makes possible the achievement of certain aims that cannot be accomplished by individuals in its absence . It is premised upon the notion that an “investment” in a relationship will ultimately result in some sort of “return”. In other words, social capital has (1) a relational element residing in the social organizations of which the individual is a member, and (2) a material element that relates to the resources to which that individual has claim by virtue of his or her membership within the group. Accordingly, social capital enables individuals to use the relationships they develop to “get by” (e.g., gain emotional support and caregiving) or to “get ahead” (e.g., information sharing) (Lin, 2001), both of which have implications for health and well being.

The contribution of social capital to health has been demonstrated in a variety of fields, particularly within epidemiology. Wilkinson (1996) first introduced social capital to the public health field, arguing in 2000 that “an important part of the social gradient in human health is attributable to the direct effects of social status, rather than to other influences on health like poorer housing, diet and air pollution” (p. 413). Since then, Macinko and Starfield (2001) determined social capital has been applied in four ways in the epidemiology literature: “(1) as an explanatory ‘pathway' in the relationship between income equality and health status; (2) as a factor in the study of social networks and health; (3) as a mediator of the performance of health policies or reforms; and (4) as synonymous with social deprivation or social cohesion in relationship with violence and crime” (p. 400). Meanwhile, Szreter and Woolcock (2004) noted social capital has links to health in three main ways: social support, inequality, and political economy. Our intent here by noting the various ways social capital has been studied is simply to demonstrate the breadth of the social capital scholarship within the epidemiological literature. More importantly, we emphasize that the volume and diversity of the empirical evidence demonstrating the significance of social capital as a determinant of at least some important health outcomes is quite impressive. Indeed, health researchers have long known that, at an individual level, networks, social participation, and supportive social relationships are good for individual health. People with strong social ties, for instance, have mortality half or a third of that of people with weak social ties (Berkman, 1995; House, Landis & Umberson, 1988), and low social support predicts coronary heart disease (Bosma et al., 1997). Notwithstanding the importance of these findings, studies in epidemiology have focused on social capital and its effects without considering context, notably place, as a serious dimension in such examinations.

Third Places

Here, we use the term place deliberately, in contrast to space , which is “a realm without meaning” (Cresswell, 2004, p. 10). Place is defined by more than biophysical elements; it refers to the socio-cultural meanings and emotional attachments held by an individual or group for a spatial setting. Accordingly, this conceptualization recognizes that places are social constructions insofar as their meanings are “created and reproduced through interpersonal interaction, formalized in social behaviour, and ultimately persist in collective memory” (Stokowski, 2002, p. 372). Put another way, the accumulation of experiences within a place personalizes it and gives it meaning (Stedman, 2003; Tuan, 1977). By attributing meaning to a space, individuals become attached to the meanings themselves (Stedman, 2003). Consequently, “the connections people have with a place extend far beyond use; they are layered with very passionate and deep-seated personal elements” (Cheng, Kruger & Daniels, 2003). Ultimately, Stokowski (2002) argued, “each effort to create a place becomes an elaboration of the beliefs and values of some collection of people, expressed and fostered in their promotion of a preferred reality” (p. 374). The construction of place, therefore, involves a process of relationship building that ultimately reflects a collective identity that we believe can be used as a resource to aid in the maintenance and enhancement of individual health. This proposal aims to investigate this possibility.

In particular, we are interested in third places , informal gathering places apart from home (the first place) and work (the second place). Oldenburg, the originator of this concept, defined third places as “havens of sociability where conversation is the main activity and conviviality prevails” (2003, p. 1373). In his writings about third place, Oldenburg has argued third places give extended meaning to the concept of the support group. That is, they provide “not only emotional support but practical assistance as well. As acquaintances evolve into friends, the desire to help others grows. Needed items are loaned or given, as is skill, advice, and expertise. Time, effort, and money are saved when needs and problems are mentioned in the company of friends” ( Oldenburg , 2003, p. 1375). This description is consistent with social capital theory, yet Oldenburg and other scholars have failed to identify the explicit connection. It does, however, fit well with a theoretical framework we have developed to explain the process of social capital development for health and well-being (Glover & Parry, 2005).

A Model of Social Capital Development

Our model (see figure 1) begins with sociability at its core. Indeed, if social capital is about anything, it is about what Portes (1998) called “the positive consequences of sociability” (p. 2). Settings, like third places (e.g., Gilda's club), that encourage social contact draw relative strangers together routinely and frequently, thus building a durable social network for those involved. Moreover, these social contexts serve an important function in terms of facilitating the ongoing maintenance and sustainability of social relationships. Nahapiet and Ghoshal (1998) noted, “social relationships generally, though not always, are strengthened through interaction but die out if not maintained” (p. 258). This observation ultimately speaks to an accepted notion upon which social capital is premised: The maintenance and reproduction of social capital are made possible only through the social interactions of members and the continued investment in social relationships (Portes, 1998). Repeated social contact reaffirms the sociable bonds among individuals. To this end, ongoing sociability is paramount to the sustainability of relationships that provide some return to the individual. 

The relationships developed in social contexts can lead to certain spin off effects or byproducts of those relationships. These by-products, conceptualized here as social capital (e.g., norms of reciprocity, obligation, group sanctions), are crucial to an individual's health, for they can facilitate three forms of action: (1) expressive, (2) instrumental, and (3) obstructive. The first, expressive action , fits within the social support school of thought insofar as it facilitates emotional support, thereby helping individuals maintain their emotional well-being. Here, group solidarity is cemented by a common experience of adversity (e.g., dealing with cancer). The second form of action, instrumental , is tied to the material dimension of social capital, which gives members of a social network access to resources. Acquiring valuable information from friends and acquaintances is one of the most common, yet important by-products of relationships. Cancer patients, for instance, may share their treatment experiences, notes about doctors, and various tips or advice they received regarding their conditions. By providing access to this information, these individuals help to advance their own health and that of their friends who are also dealing with cancer. While getting ahead does not necessarily mean “curing” their cancer, the information they gain and put to use places them further along in coping with their experiences and aids in their decision making processes. In short, instrumental action allows individuals to “get ahead” by gaining access to resources to which they would otherwise have no access. Finally, the third form of action, obstructive , recognizes the harm relationships can have on individual health. Correspondingly, its inclusion in the model provides a more balanced perspective related to social capital and health insofar as it acknowledges the ill-effects relationships can create for individuals. In direct contrast to instrumental action, obstructive action can represent a set back or keep an individual from getting ahead. In our findings from our study of women dealing with infertility, we offered many examples related to this outcome. Notably, research participants who remained infertile felt compelled to support friends who conceived or adopted children, even though such support made them feel uncomfortable and upset about their own situations. The activities that generated stress in the participants were, more often than not, child centered activities such as birthday parties, baby showers, toy-shopping, Easter egg hunts, and Halloween parties. All of these events served to remind the research participants of their own childlessness, thereby creating further stress in their lives. Nevertheless, the social norms and sanctions embedded in their friendships (e.g., social capital) compelled them to continue to support their friends under stressful circumstances. We aim to further explore the potential outcomes (e.g., expressive, instrumental, and obstructive action) of social capital developed in the context of Gilda's Club, with particular emphasis on the role of place as a container for the sociability that impacts upon health and well-being.